Heart failure a growing threat to Filipinos

Did you know that heart failure (HF) or palyadong puso in the vernacular is a silent killer that has been creeping in our midst? This is largely brought about by an increase in the prevalence of risk factors, like high-blood pressure, high cholesterol, diabetes, obesity and smoking.

As the name implies, heart failure is a serious medical condition that occurs when the heart does not pump enough blood to meet the oxygen demands of the body. Despite improvement in survival rates with current therapies, patients with HF have a poor prognosis. One in five people aged over 40 will develop HF in their lifetime, and patient numbers are increasing. Half of all patients will die within five years of being diagnosed with HF. HF is the most common cause of hospitalization in people aged over 65.

Signs and symptoms

When the heart does not work optimally, it may not pump enough blood to support your other organs and may cause you to retain fluids. This can cause shortness of breath with physical exertion or when lying down, persistent cough or wheezing, reduced ability to exercise and weakness. A lot of patients will complain that they are asthmatic when in fact they have heart failure. Other symptoms are sudden weight gain from fluid retention and swelling in the lower extremities and abdomen. Some patients also have rapid or irregular heartbeat, and increased frequency of urination at night. Consult your doctor promptly when you have these symptoms.

Over time, if not treated properly, HF leads to a cascade of changes, punctuated by acute episodes, that cause severe fatigue; breathlessness; damage particularly to the heart, kidneys and liver; and ultimately death.

Causes

Coronary artery disease is the most common cause of HF. It develops when fatty deposits (plaques) build up over time in the arteries that supply blood to the heart muscle—a process called atherosclerosis. The plaque buildup can narrow the arteries and cause reduced blood flow to the heart. If these plaques rupture, a heart attack occurs, causing a blood clot to form. The blood clot may block blood flow to an area of the heart muscle, weakening the heart’s pumping ability and often leaving permanent damage. If the damage is significant, it can lead to a weakened heart muscle leading to HF.

Another common cause of HF is hypertension. High-blood pressure causes the heart to work harder to circulate blood throughout the body. Over time, the heart muscle becomes thicker to compensate for the extra work it must perform. Eventually, the heart muscle may become either too stiff or too weak to effectively pump blood.

Less common causes of HF include faulty heart valves, damage to the heart muscle (cardiomyopathy due to certain diseases, alcohol and substance abuse), inflammation of the heart muscle (myocarditis, usually caused by a viral infection) and congenital heart defects.

Many Filipinos at risk

Although there are currently no definitive local statistics on the prevalence of HF, the latest National Nutrition and Health Survey (NNHeS) conducted in 2013 show that many Filipinos have risk factors for HF. These include hypertension, obesity, smoking, high cholesterol and diabetes.

Dr. Carolyn Lam’s editorial published in the March 2015 issue of the online journal ESC Heart Failure, warned that HF is a growing problem in Southeast Asia fueled by a rapidly growing population with HF risk factors, particularly hypertension and diabetes. Citing the World Health Organization 2014 global status report, the editorial noted that the risk of prematurely dying from noncommunicable diseases (NCDs) in the Philippines (28 percent) is more than double in the United Kingdom (12 percent). NCDs include cardiovascular diseases such as HF.

The Philippine Heart Association Council on Heart Failure, chaired by Dr. Paul Ferdinand Reganit, is currently doing the HF registry among participating hospitals.

Novartis is also supporting a research study that aims to determine HF prevalence in the Philippines and the economic burden the debilitating condition puts on patients and their families, particularly in terms of health-care expenditures, lost productivity, and impact on quality of life. Data generated by these studies can help enhance the medical treatment and health insurance coverage of Filipinos with HF.

This “Keep It Pumping” column is an initiative of the Philippine Heart Association which aims to promote and sustain HF understanding and advocacy to educate and empower patients, their caregivers and the public to improve health outcomes.

(Dr. Alex T. Junia is the president of the Philippine Heart Association.)